Provider Demographics
NPI:1083897938
Name:HILL, MARCELLA RAE (LPN/ IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:RAE
Last Name:HILL
Suffix:
Gender:F
Credentials:LPN/ IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-9766
Mailing Address - Country:US
Mailing Address - Phone:405-247-6590
Mailing Address - Fax:
Practice Address - Street 1:300 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-9766
Practice Address - Country:US
Practice Address - Phone:405-247-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104-20860163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant